With tax rejected, how to care for poor?

Published: Tuesday, June 18, 2013 at 11:55 p.m.

Last Modified: Tuesday, June 18, 2013 at 11:55 p.m.

MANATEE COUNTY - For many years, Manatee County’s $45 million Health Care Trust Fund seemed fit to carry poorer residents to better health for decades to come.

But a stumbling economy helped undermine that plan and, with the fund expected to run dry by 2015, Manatee voters on Tuesday overwhelmingly rejected the idea of adding a half-cent sales tax increase to replenish it.

The options now are limited as Manatee faces a struggle increasingly common to governments across the country — how to shoulder the cost of health care for the working poor.

Doctors and hospitals will have to absorb more of the costs, at least initially, while possibly charging more to those with insurance. Some residents could go longer before getting treatment, making their ultimate care more expensive.

If the situation persists, Manatee facilities may find it harder to recruit and retain physicians. Eventually, the impact on lower-income patients could result in medical conditions that worsen or are left untreated.

Federal health care reform will not offer an immediate solution in Florida. The Legislature this year considered expanding Medicaid coverage under the Affordable Care Act to include the working poor. The expansion would have extended coverage to the needy in Manatee as the local Health Care Trust Fund ran out of money. But while the Senate and Gov. Rick Scott supported the Medicaid expansion, lawmakers in the House said no — this, despite the offer of full federal funding for the first three years of expansion.

Several groups, including area hospitals, are continuing to lobby lawmakers to reopen the debate.

Local health care facilities that previously used the Manatee funding to provide specialized services to those without insurance will no longer be able to take these needy patients. More of those patients will end up in already-crowded emergency rooms.

Because ERs are required by law to take in all patients who come to their doors — whether or not they have the ability to pay — the costs will be written off, the burden shared by those with insurance.

Or, according to Manatee County Administrator Ed Hunzeker, the Manatee Board of County Commissioners might revisit the issue next year as another sales tax referendum. The county also might opt to increase property taxes.

The big idea

Back in 1984, it seemed like a great idea, both innovative and clever: Sell ailing Manatee Memorial Hospital and put the proceeds into a trust fund, using the interest to provide health care for the poor. Manatee became a model of ingenuity.

The Health Care Trust Fund soared with the stock market. Manatee kicked in $23 million, and $9 million was contributed each year from the fund.

But rising medical costs, an expansion of the program to Blake and Lakewood Ranch medical centers, and a swelling of the ranks of the poor and uninsured in the recession have nearly depleted the funds.

The tax increase proponents didn’t think it was that big a deal: Other counties already assess 7 cents in tax on sales.

The proposed Manatee County tax boost, from 6.5 to 7 percent, would have applied on most items, excluding food and medicine. Tourists and renters would have shared the burden, rather than just property owners.

But as the referendum approached, arguments grew.

Some residents likely were deterred by bickering over arcane issues related to the wording of the referendum. Antitax sentiment and a pervasive dread of government interference inflamed opinion.

And while a couple of single-issue votes involving taxes in Manatee’s past were successful, those involved services for children. This was a different population of recipients.

“Some people are unsympathetic toward the working poor who don’t have insurance,” Hunzeker said. “They have no sympathy for indigents.

“But don’t look at them, look at the provider.”

He said a study five years ago revealed Manatee had a difficult time attracting physicians. Failing to compensate them for treating low-income residents could send doctors packing, he said.

“Next time you go to your health care provider and your provider isn’t there, now you have a health care crisis,” he said.

Providers, who stood to gain from the tax, formed the Healthy Manatee organization to support it. When turnout appeared low Tuesday, they encouraged workers from local health care facilities to head for the polls after work.

It wasn’t enough.

Michele Garden, a registered nurse and director of One Stop, which provides a variety of medical services to the poor in Bradenton, is baffled by the reluctance of people to pay the added tax.

“It shouldn’t have come to this, this doing battle over humans,” she said Tuesday. “I don’t mind paying 7 percent sales tax when I’m in Sarasota. I don’t think people would notice.”

She said poorer residents will still need urgent care.

“Now they will all pile into the emergency room,” Garden said.

She said she thinks Healthy Manatee could try to get the tax increase on the ballot for another vote before the fund is fully exhausted.

Mary Ruiz, president and CEO of Manatee Glens, a nonprofit provider of addiction and mental health services, said without the sales tax a large number of needy people will go without care.

Ruiz said she sees just two choices now — cut services or increase property taxes.

<p><em>MANATEE COUNTY</em> - For many years, Manatee County's $45 million Health Care Trust Fund seemed fit to carry poorer residents to better health for decades to come.</p><p>But a stumbling economy helped undermine that plan and, with the fund expected to run dry by 2015, Manatee voters on Tuesday overwhelmingly rejected the idea of adding a half-cent sales tax increase to replenish it.</p><p>The options now are limited as Manatee faces a struggle increasingly common to governments across the country — how to shoulder the cost of health care for the working poor.</p><p>Doctors and hospitals will have to absorb more of the costs, at least initially, while possibly charging more to those with insurance. Some residents could go longer before getting treatment, making their ultimate care more expensive. </p><p>If the situation persists, Manatee facilities may find it harder to recruit and retain physicians. Eventually, the impact on lower-income patients could result in medical conditions that worsen or are left untreated.</p><p>Federal health care reform will not offer an immediate solution in Florida. The Legislature this year considered expanding Medicaid coverage under the Affordable Care Act to include the working poor. The expansion would have extended coverage to the needy in Manatee as the local Health Care Trust Fund ran out of money. But while the Senate and Gov. Rick Scott supported the Medicaid expansion, lawmakers in the House said no — this, despite the offer of full federal funding for the first three years of expansion.</p><p>Several groups, including area hospitals, are continuing to lobby lawmakers to reopen the debate.</p><p>Local health care facilities that previously used the Manatee funding to provide specialized services to those without insurance will no longer be able to take these needy patients. More of those patients will end up in already-crowded emergency rooms.</p><p>Because ERs are required by law to take in all patients who come to their doors — whether or not they have the ability to pay — the costs will be written off, the burden shared by those with insurance.</p><p>Or, according to Manatee County Administrator Ed Hunzeker, the Manatee Board of County Commissioners might revisit the issue next year as another sales tax referendum. The county also might opt to increase property taxes.</p><p><B>The big idea</b></p><p>Back in 1984, it seemed like a great idea, both innovative and clever: Sell ailing Manatee Memorial Hospital and put the proceeds into a trust fund, using the interest to provide health care for the poor. Manatee became a model of ingenuity.</p><p>The Health Care Trust Fund soared with the stock market. Manatee kicked in $23 million, and $9 million was contributed each year from the fund.</p><p>But rising medical costs, an expansion of the program to Blake and Lakewood Ranch medical centers, and a swelling of the ranks of the poor and uninsured in the recession have nearly depleted the funds. </p><p>The tax increase proponents didn't think it was that big a deal: Other counties already assess 7 cents in tax on sales.</p><p>The proposed Manatee County tax boost, from 6.5 to 7 percent, would have applied on most items, excluding food and medicine. Tourists and renters would have shared the burden, rather than just property owners.</p><p>But as the referendum approached, arguments grew. </p><p>Some residents likely were deterred by bickering over arcane issues related to the wording of the referendum. Antitax sentiment and a pervasive dread of government interference inflamed opinion. </p><p>And while a couple of single-issue votes involving taxes in Manatee's past were successful, those involved services for children. This was a different population of recipients.</p><p>“Some people are unsympathetic toward the working poor who don't have insurance,” Hunzeker said. “They have no sympathy for indigents. </p><p>“But don't look at them, look at the provider.”</p><p>He said a study five years ago revealed Manatee had a difficult time attracting physicians. Failing to compensate them for treating low-income residents could send doctors packing, he said.</p><p>“Next time you go to your health care provider and your provider isn't there, now you have a health care crisis,” he said.</p><p>Providers, who stood to gain from the tax, formed the Healthy Manatee organization to support it. When turnout appeared low Tuesday, they encouraged workers from local health care facilities to head for the polls after work.</p><p>It wasn't enough.</p><p>Michele Garden, a registered nurse and director of One Stop, which provides a variety of medical services to the poor in Bradenton, is baffled by the reluctance of people to pay the added tax.</p><p>“It shouldn't have come to this, this doing battle over humans,” she said Tuesday. “I don't mind paying 7 percent sales tax when I'm in Sarasota. I don't think people would notice.”</p><p>She said poorer residents will still need urgent care.</p><p>“Now they will all pile into the emergency room,” Garden said.</p><p>She said she thinks Healthy Manatee could try to get the tax increase on the ballot for another vote before the fund is fully exhausted.</p><p>Mary Ruiz, president and CEO of Manatee Glens, a nonprofit provider of addiction and mental health services, said without the sales tax a large number of needy people will go without care.</p><p>Ruiz said she sees just two choices now — cut services or increase property taxes. </p><p><B>Herald-Tribune Staff Writer Elizabeth Johnson contributed to this report.</b></p>